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Because of the anatomical proximity, infection of posterior upper teeth can spread into the maxillary sinus. When confronted with a large persistent periapical lesion on a posterior maxillary root-treated tooth, the practitioner should question the quality of the previous endodontic treatment, evaluate the impact of the potential causes of failure and consider, in the majority of cases, the conservative non-surgical retreatment instead of extraction or periapical surgery of the dental element. This paper reports two cases of healing of extensive periapical bone destruction and of the co-existing sinus pathology of odontogenic origin after non-surgical endodontic retreatment of previously root-treated upper molars. Misconceptions concerning the role of epithelium in the periapical lesion are discussed. Also, emphasis is put on the need of precise radiological diagnosis, pre-operatively as well as post-operatively to ascertain healing and to avoid unnecessary delay in the appropriate management of these patients.

Introduction: Most tympanoplasty techniques require skin incision of the external auditory canal. This step is not without morbidity and postoperative complications such as delayed healing, granulation tissue, lateralization, blunting and iatrogenic cholesteatoma. For small or midsize non-marginalized tympanic membrane perforations of the posterior or inferior quadrants, a transmeatal approach without incision of the cutaneous epidermis of the external auditory canal can theoretically offer advantages such as rapid healing and reduced postoperative complications. In this paper we present the preliminary results of a tympanoplasty technique with a retroauricular approach without skin incision of the canal and an overlay graft.

Materials and methods: We performed 10 tympanoplasties without skin incisions for small or midsize non-marginalized perforations, which do not exceed one third of the tympanic membrane surface, located in the inferior or posterior quadrants.

Results: With a minimum follow up of 3 months all patients showed excellent anatomical results without complications. Nine of them closed their average air bone gap at less than 10 dB.

Conclusion: When anatomically feasible, our technique combines a post auricular approach and the absence of skin incision. It ensures rapid healing, preserves the anatomy of the eardrum and external auditory canal and reduces the risk of blunting and lateralization phenomena. The main difficulty concerns the cleavage of the epidermal and fibrous layer.

Introduction: Management of chronic perforation and severe posterior and/or attic Retraction Pocket (RP) or atelectasis of the tympanic membrane continues to be one of the most difficult problems for otologists.

Aim of the study: To analyse the usefulness of the tympanic membrane reconstruction with tragal cartilage.

Materials and methods: The study included 27 patients with chronic perforation or severe RP operated by the same surgeon, using tragal cartilage tympanoplasty. Seven supplementary procedures were required for recurrent cholesteatoma (second-look surgery).

Results: There has been no recurrence of the retraction and the perforation. Nineteen ossicular reconstructions were necessary with acceptable hearing results.

Conclusions: Tragal cartilage has made a significant improvement in the tympanic membrane reconstruction procedure. A large thin cartilage combined with a titanium prosthesis can provide an excellent anatomical result, perfect stability and good functional outcome. When the eardrum is intact, we still use allografts of costal cartilage for the management of the retraction pocket or titanium prosthesis.

According to recent advances it is assumed that the gastroesophageal reflux (GER) is a possible co-promoting factor of the squamous-cell carcinoma development in the upper parts of the gastro-intestinal and respiratory systems, considering the higher frequency of lesions due to acid in the studied population interested by GER. The aim of this study is to investigate 274 patients with malignant neoplasm of the oral cavity, of the pharynx and of the larynx, by esophago-gastro-duodenoscopy (EGD) and to compare the incidence of GER in this group with a control group of healthy patients from their hospital. Acid exposure in the upper level of the esophagus often remains unknown using traditional pH-monitoring, especially if no pharyngeal probe is used. When necessary a good diagnostic test is EGD with mucosa biopsy; it allows to directly examine the lesion. We retrospectively studied the data of 274 patients suffering from a cancer of the upper aero-digestive tracts by EGD in order to diagnose lesions caused by GER. We compared non-smoking patients affected by GER and tumours a control group of healthy patients. Statistical analysis revealed a significant difference between the two groups using the z-Test (p = 0.0001). In our study, based on endoscopic data, we observed a high percentage of non-smoking patients affected by GER and squamous-cell carcinoma of the upper parts of the airways and the gastrointestinal system. For this reason we consider GER as a possible co-promoting factor of cancer in some patients.

The present paper reports on the results of a retrospective study using 678 Hz susceptance-conductance tympanometry performed on abnormally high admittant middle ears. High admittance was proven to be caused by (partial) disruption or lysis of the ossicular chain. Retrospective analysis shows that 678 Hz tympanometry seems to be more accurate in the differential diagnosis of ossicular chain disruptions compared to CT-imaging of the ossicular chain (88% versus 81% correct identification respectively). Classic tympanometry using a probe frequency of 226 Hz was abnormal in only 43% of the cases.

In this paper, the authors describe, in details, the techniques and the indication of CT scanner and MRI for the evaluation of neurosensory deafness. CT scanner allows to study bony and pneumatized structures of the ear. CT scanner is mostly indicated for the study of congenital deafness, post-trauma deafness and unilateral progressive deafness for which the otoscopy is normal. MRI allows the study of fluid compartments, nerves, vascularization and tissue. MRI will be chosen to evaluate sudden sensory neural deafness and unilateral deafness. However, it is worth to mention that CT scanner and MRI are complementary and that precision of the imaging system as well as a strong collaboration between the otolaryngologist and the radiologist are mandatory.

The Belgian Experience with the Vibrant Soundbridge Prosthesis. The authors present the first results obtained with 13 patients implanted with the Vibrant Soundbridge, a semi-implantable electromagnetic hearing device. The first patient was implanted in October 1998. The results show that there were no significant modifications of the hearing thresholds after implantation. The average functional gain was 30 dB in tonal audiometry and 25.6 dB in vocal audiometry. All the patients are satisfied with the device and wear it daily.

Background: The purpose of this study was to determined the functional outcome of surgically treated head and neck cancer patients who required more than "standard" microsurgical reconstruction.

Methods: Data concerning all patients with head and neck cancers, who underwent free-tissue transfers in our institution between January 1, 1994 and August 31, 1999 were reviewed. The cases of tumor recurrences and those with micro-surgical complications were excluded. Among 68 primary microsurgical reconstructions, we identified five cases where limitations in speech and/or swallowing required additional flap procedures. An objective assessment of speech and swallowing could be performed in four patients.

Results: In these five patients up to three consecutive additional procedured including three free-tissue transfers in one case, had to be performed mainly because of secondary contraction of the surrounding irradiated tissue. A total of 13 pedicled and free flaps were transferred to the head and neck. Three patients underwent two consecutive free tissue transfers. The additional reconstructions were requested to improved tongue mobility in three patients and to enlarge the upper digestive tract in two patients. The mean follow-up was 23 months (range : 9-53 months). Functional evaluation was rated average in three patients and poor in one patient. One patient died before functional evaluation could be performed because of disease. The four patients judged the final cosmetic result as satisfactory.

Conclusion: We report five cases of head and neck microsurgical reconstructions where additional flap procedures were requested because of inadequately restored speech or nutrition capabilities. We show that, maybe because of extensive fibrosis, only limited improvement in the functional outcome can be expected despite the use of even sophisticated microsurgical reconstructions. This paper supports the idea that every effort should be put in the initial reconstruction, as further procedures are of poor functional prognosis.

Ramsay Hunt syndrome (RHS) is herpes zoster of the facial nerve, frequently associated with VIII cranial nerve involvement, but on rare occasions other cranial nerves are affected as well. We present the case of a 63-year-old woman with RHS with involvement of V, VII, VIII, IX, and XII cranial nerves. The patient showed significant improvement after treatment with acyclovir and prednisolone. RHS should be recognized as a polycranial neuritis characterized by damage to sensory and motor nerves, including the facial nerve and the auditory-vestibular apparatus. Early institution of treatment with antiviral agents may help hasten healing. Involvement of the XIIth cranial nerve has not been reported previously.